Approaches to reducing infant mortality in Illinois.
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Birth Weight↗
Biomedical subjects
B J Turnock
Publications and source records attributed to B J Turnock.
Evaluation of an EMS regional referral system using a tracer methodology.
To improve patient care, cost effectiveness, and resource utilization, the Illinois EMS Program attempted to regionalize emergency medical care services by identifying referral centers for critically ill and injured patients. The performance of one referral region was evaluated applying a tracer method designed to tract patients whose clinical conditions, as determined by a clinical panel, required treatment at a designated regional center. The proportion of patients reaching the appropriate centers suggests that the regional referral system under study appropriately moved only about one half the patients with the tracer conditions to the designated referral center. Additional patients were transferred to hospitals with greater emergency department capabilities, although these hospitals were no formally designated centers. Except for low birth weight, factors that might be associated with referral patterns indicate no significant differences between those patients at the regional center and those treated elsewhere.
Adolescent↗
Incorporating outcome standards into perinatal regulations.
State and local governments license and monitor hospitals to ensure that a minimum acceptable level of care is present as one means of improving the outcomes and health status of patients served. Standards developed to achieve these purposes, however, have focused almost exclusively on the inputs and processes believed to be necessary for quality care and optimal services. Even when the overwhelming consensus of professionals and providers is that such standards impact positively on outcomes, direct evidence of such causal relationships is often lacking. In 1983, the Chicago Department of Health began incorporating direct measurement of outcomes into its mandated regulatory functions for one operating unit of hospitals--the maternity and newborn services. Crude perinatal and neonatal mortality rates for Chicago hospitals are adjusted using an indirect standardization process that controls for both race and birth weight. This process allows for the calculation of adjusted mortality rates and standardized mortality ratios (SMRs) that are used as an initial screening instrument. Additional evaluation and investigation activities are then directed to hospitals identified through the initial screening process as meriting further study. Hospitals are also evaluated for compliance with the traditional standards and requirements. Information derived from both outcome and compliance evaluations is used to determine monitoring and regulatory activities such as penalties, waivers, and periodicity of future inspections. Use of this Outcome-Oriented Perinatal Surveillance System appears to be an objective, understandable, and acceptable basis for establishing monitoring, evaluation, and regulatory strategies for hospitals with maternity and newborn units.
Birth Certificates↗
Local health department effectiveness in addressing the core functions of public health.
Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and least for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than 40 percent of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.
Community Health Services↗
Implementing and assessing organizational practices in local health departments.
One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been effective. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public's health.
Government Agencies↗
A strategy for measuring local public health practice.
The national health objectives for the year 2000 call for 90% of the population to be served by a local health department (LHD) that is effectively addressing the core functions of public health. Achieving this objective requires approved definitions for effectiveness as well as a system for ascertainment. In 1990 when this objective was established, no baseline data were available, and no accepted methods of measuring health department effectiveness were in use. Our approach to the development of a surveillance system to measure the effectiveness of LHDs has been to translate the three core public health functions characterized by the Institute of Medicine and the 10 practices delineated by the Centers for Disease Control and Prevention (CDC) and the national public health practice organizations into practice performance measures that could be judged as met or not met at the level of a jurisdiction served by a LHD. As part of our effort to develop a surveillance system to measure local public health practice, performance measures that characterize the 10 public health practices and their related core functions were developed and field-tested with state local health liaison officials and local health departments over a two-year period. Obtaining input from these sources is essential to establishing their validity and is a critical aspect of building nationwide consensus for appropriate measures of effective local public health practice. The results of these efforts led to the establishment of a proposed surveillance instrument comprising 10 performance standards and 29 associated indicators. We describe two approaches to its use.
Community Health Services↗
Roles for state-level local health liaison officials in local public health surveillance and capacity building.
In 27 state health agencies, local health liaison units or officials (LHLOs) are formally assigned responsibility for fostering a close working relationship between the state health agency and local health departments (LHDs). Yet in most other states, other agency staff carry out these responsibilities informally. Even where formal LHLOs exist, the assigned functions and specific activities vary, with little consistency across states other than serving as a potential or, in most cases, a real and vital linkage between LHDs and the state agency. This linkage places the LHLO in a unique position to have extensive knowledge, data, and information on LHD activities and to play an important role in assessing and improving local public health practice. This report examines aspects of the LHLO-LHD relationship in terms of potential LHLO roles in LHD practice surveillance and capacity building. Surveys of LHLOs and LHDs indicate that both support the development of surveillance tools to measure LHD effectiveness as a means to enhance capacity building efforts. Although LHLOs may not know or have the specific information immediately available to assess local public health practice for LHDs in their state, they report being able to obtain the information if necessary and with sufficient time. Further, LHDs are willing to share information concerning local public health practice with their state health department, particularly with their state LHLO. These findings suggest that LHLOs could be extensively involved in surveillance strategies beyond merely collecting and aggregating information provided by LHDs.
Administrative Personnel↗